HomeMy WebLinkAboutMortgage_Caudill STATEMENT OF MORTGAGE OR CONTRACT INDEBTE 1 t:,,,,, p Townshi Year
.a FOR DEDUCTION FROM ASSESSED VALUATION - I
'• State Fonn 43709(R13/10-15)
Presatbed by Department of Local Government Finance SEP 2.8 2016 File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates 1) Must Propedy.Mu eked with the County Audito or County Recorder°Um••••�r 71 t- -''"' ' rty iS ' County Auditor
Musa be filed or
located on or before January 5 of the immediately succeeding calendar year. • NTY AUDITOR ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
nt or haO b -see on -rse side
Appr� (o� � ami /I - D
T - g�D�' Key number/legal•- r'tion Read number Page number
> yl r a to— 7-6 • -a do co 'y 086 oa / aoieia / 9011
Assessed value of real property as of (Mortgage/Contract Indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant the sole
assessment dais,current year assessment date,current year data of application legal or equitable owner?
`-7 (4 900 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
ETFC U
Address of mortgagee or contract seller(number and street city,state,and ZIP code) r� l (�n '�'
Name of assignee or other owner or holder of mortgage R v` p \.` `-�r� 1% —1C.
- —
Address of assignee(number and street,city,state,and ZIP code) I✓i u.
"r11� ,yoo . 0o
Does applicant own property in any If yes,what county? What Taxing District? a b , (Q - ■q L 6 of deduction
other county
in Indiana? ❑Yes ❑No /I
A person is not entitled to this deduction unless the person has a balance on the w• .,..._. a-'-3-I b din the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is me oaaa _
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20 -
Signature of County Auditor County Date(month,day,year)
•
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
S- re(owner's lull name) , Date( day,year)
cu a -a8 -/G
F lint of applicant(number and sheet a ,state,and LP e)
T-9(.074 W 67�5J �v�x�.rct& -y7101S
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.